=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922185958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAV-KIM PORTABLE X RAY SERVICE CO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8235 CHRISTIANA AVE
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-337-1000
-----------------------------------------------------
Fax | 224-337-0100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1126
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60065-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-337-1000
-----------------------------------------------------
Fax | 224-337-0100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ETAI SOOLIMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 224-337-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320700000X
-----------------------------------------------------
Taxonomy Name | Physical Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------